Provider Demographics
NPI:1114224318
Name:MARTIN, JAVIER (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:JAVIER
Middle Name:
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 FONTAINEBLEAU BLVD STE 2D1
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-7013
Mailing Address - Country:US
Mailing Address - Phone:305-227-8088
Mailing Address - Fax:305-227-8089
Practice Address - Street 1:175 FONTAINEBLEAU BLVD STE 2D1
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-7013
Practice Address - Country:US
Practice Address - Phone:305-227-8088
Practice Address - Fax:305-227-8089
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-24
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 59190261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation